Malaysian Healthy Ageing Society The progressive depressing & - - PowerPoint PPT Presentation

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Malaysian Healthy Ageing Society

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The progressive depressing & frightening picture in the dark hole of the elderly:

The physical limitation of joint pain & stiffness. The progressive loss of hearing, eyesight, memory The increasing intolerance & difficult relation with family The mental depression, The burden to the family, eventually home bound, Wheel chair dependent & bed ridden. The loss of ADL, nutrition & hygiene The loss of communication, fighting spirit & the will to live & silent suffering

Can we afford to look after the dependent elderly?:

• 1. The country
• 2. The community/society
• 3. Special agencies
• 4. Associations
• 5. Organizations/Charities
• 6. Families/Children

We cannot choose our parents Genetic Aging & Risky genome

From Scientific American

The Choice?? The journey of our life Preserving body machine

Age 100 yrs floating, mobile & independent. Age 75 yrs depressed, immobile & dependen

• 1.Collagen Degeneration

(Skin Atrophy thinning & pigmentation)

• 2.Osteoporosis

(Risks of Spine/Hip/Radius Fractures)

• 3.Joint Failure

(Osteoarthritis)

• 4.Neurophathy/slow reflexes
• 5.Atherosclerosis

(Ischemic limbs/heart/brain)

• 6.Generalised Tissue Atrophy
• 7.Deformity from arthritis, muscle

weakness & imbalance

• 8.Failing eyesight, Hearing loss
• 9.Loss of major organs reserve

The Aging Body

Slow reflexes, muscle weakness, loss of balance & inability to compensate in the elderly

• Fall. A sudden traumatic event

change life style

Extended Elbow Supinated forearm Extended wrist Flexed Elbow Pronated forearm Extended wrist Flexed Elbow Neutral forearm Extended wrist Falling backward Falling forward Radial load Ulnar load

(Inevitable by-products of bipedal locomotion—we use our Hand to break the falls)

Statistics

• Asia: 1.06 billions aged over 65 yrs in 2050
• Singapore: 38% population over 65 in 2050
• America: 85 yrs & above fastest growing

segment reaches 208000 in 2030

• 80yrs is the new 50 yrs of 1950
• Evidences that major elective surgery in the

80 yrs has similar risk than the young.

Media Publicity

• “Increasing medical efforts to treat the

very old”

• “Good Survival rates in Heart Surgery for

the aged” From improvement in medical technology and safety of surgical technique

Increasing needs for Surgery in the elderly with rising aging population (Harvard School of public health)

Surgery at the end of life(2008) Last year of life: 1 in 3

• Last month of life: 1 in 5
• Last week of life: 1 in 10

Surgery at final year of life(2008) 65 yrs & above : 38.4% 80 yrs & above : 35.3% 90 yrs & above : 23.3%

End-of-Life Surgery

• Many probably failed to improve quality &

length of lives(Asisha Jha)

• Related to where elderly lives

Muncie, Indiana -- Highest (34%) Honolulu ----------- Lowest (12%)

Risks of Surgery in the Elderly

• Generalised multi- systemic diseases
• Multi-joints involvement
• Mental depression
• Anemia & poor nutrition
• Multi-drugs therapy
• Poor musculature & difficult

rehabilitation

• Socio-economic dependence
• risks of stroke, cardiac, pneumonia,

UTI, pressure sores The elderly fares poorly for emergency surgery The elderly can tolerates elective surgery but recovery is slow The elderly has no tolerance for complications from poor reserve

Benefits of Surgery in the Elderly in Sustaining active lifestyles

• By-pass surgery, valves replacement
• Peripheral vascular surgery
• Minimally invasive & endoscope surgery
• Cataract surgery
• Joint replacement surgery
• Spine surgery/Fracture Fixation
• Decompression in Peripheral nerve &

Tendon Surgery

Pristine, smooth, shiny, elastic articular Cartilage that absorb stress load and glide With almost 0 friction

Osteoarthritis with narrow joint space from Erosion of smooth articular cartilage (surface lesion)

Articular erosion Subchondral cyst formation from micro fracture

THJR for OA Hip

• unphysiological

Bone resorption & Loosening at bone Prosthesis interphase Revision with Larger prosthesis 1985 1995

We have created a new pattern of implant disease, a new industry in medicine. We solve the problem by exposing more

• f our own ignorance by inserting

so-called “Newer, Better and more expensive prosthesis in the joint. What we can achieve with prosthesis is a temporary spacer providing optimal function but not a perfect joint.

Bionic Man????

Is the Surgery of the elderly worthwhile?

• Should surgery be performed at all cost?
• Is Surgery affordable by the society?
• Should limited resources be diverted to benefit

the young?

• Doctor’s responsibility to allocate individual good

to common good in the society?

• Should society setting prejudice again ageism?
• Setting the “limits”?

What criteria? Who to decide?

Surgical Decisions

• Low risks, predictable outcome and

perceived benefit for the patient in the surgeon’s judgment and skill

• Affordable cost in finance, emotional

drains time to recovery and ultimate benefit for the patient

• Respect dignity, desire, wishes and

choice of the patient & relatives

Orthopedics is one of the most rewarding and enriching specialty

In improving quality of life in our

patient

OBSERVATION as one of the most Powerful tool

We always LEARN from the patient Recognize Elderly Patient is an individual that must be relevant to the family, friends, the society and the community he or she lives

We educate people about

• rthopedics

How to work and play efficiently How to reduce injuries How to live in harmony with environment How to age gracefully

We enrich our life in orthopedics

We understand our body How our body function? We appreciate our body’s movement We understand sports in relation to our body Our body is our research laboratory

There is no retirement in orthopedics

It is the betterment of one’s life In understanding limitation of human activities, Always listen to our body and adjust

• ur activities accordingly

Orthopaedic Surgery rarely prolong life span But has immeasurable contribution in improving Quality of life

We emphasize The value of living healthy life style & aging gracefully By investing in Avoid Fall at all cost